Eternal Beauty Cosmetics
          Polly Parker (SPCP-Trainer)
1480 Glendale Dr.—Wabash,In. 46992—260-563-3240
Licensed Cosmetologist,Licensed Instructor,Certified Derma-Tech, Licensed
Tattoo Artist, Board Certified Permanent Cosmetic Professional
Licensed Tattoo Artist, Board Certified-Permanent Cosmetic Professional (CPCP) Society of
Permanent Cosmetic Professionals-Trainer (SPCP)

               Registration Form

Please Mail Your Registration Form and Deposit To Polly Parker or send thru paypal. I except
credit cards by calling my office 260-563-3240.

Name--------------------------------------------------------

Address-----------------------------------------------------

City----------------------------------------------------------

State---------------------------------------------------------

Home Phone-----------------------------------------------

Business Phone--------------------------------------------

Mastercard/visa number---------------------exp date--------Signature----------------------------

Please select from the class schedule your first choice and second choice for training. For me to
maintain a high level of student/teacher ratio, my classes are limited to 2 students for better hands on
training.
Class choices are on a first come, first serve basis, so make your request early to ensure your first
choice.

Choice #1-----------------------------------------------------------

Chooice#2----------------------------------------------------------

Method of payment: Mastercard/Visa, Cash, Money Order, Check

Beginners Class------6 Days---or 2 weekends-Sat,Sun,Mon-$3,500

Advanced Class---2 Days---$1,300---3 Days--$1,500---

Beginners class fee includes a “Start up” kit ($800.00 value) providing you with all the supplies to
complete at 25 procedures, almost doubling your investment for your training. This is designed to
eliminate all the worries of “what will I need”, waiting for your supplies to arrive and get you started
right away performing permanent cosmetics applications

( ) I have enclosed my Non-Refundable deposit of $800.00 to reserve my seat and purchase my
supplies. Balance is due before day of class.
( ) I understand some states require Technicians to work with a Physician and I will find out the fact
and legalities respecting my city and state before class. A good source for this information is www.
spcp.org click on your state.